The argon and CO2 lasers in otolaryngology: Which one, when and why?

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Abstract
Electromagnetic energy in the visible and the infrared range has been recognized as a surgical adjunct for the past two decades. In otolaryngology, the CO2 and argon lasers are now being used in head and neck and otologic surgery. Thermal, non‐ionizing energy is produced by both of these lasers. When an appropriate medium absorbs the electromagnetic radiation carried by either beam, this energy is converted into heat.Absorption is different for the two wavelengths. The infrared wavelength is efficiently absorbed by water, and since biologic tissue contains 80% water, it is an ideal medium for absorbing infrared radiation. The argon wavelength is in the visible blue‐green spectrum. It is preferentially absorbed by a red medium. When absorption of radiation in the infrared range (CO2) takes place within tissue, the primary effect is vaporization; that produced by the argon laser is photocoagulation.Unlike any other surgical specialty, the discipline of otolaryngology involves surgery through more orifices, whether man‐made or natural, than any other surgical specialty. In such situations, illumination is frequently inadequate and conventional instruments further obstruct the surgeon's view of the specimen. The use of a “light scalpel” permits alteration of microscopic structures or removal of tissue under direct visualization, especially when the surgical approach is through a limited space. The CO2 laser is an ideal laser for incising, excising, vaporizing or debulking soft tissue masses with precision and good visibility. Because the argon wavelength (.488‐.515 μ) is shorter than that of the CO2 (16.6 μ), it is possible to generate a smaller spot with the argon under similar working conditions. As a visible beam, the argon wavelength is easily transportable by fiber optic light carriers. These two factors make the argon laser more suitable for precise otologic microsurgery. As a soft tissue laser the preferential absorption of Argon radiation by red tissue makes it possible for the first time to eliminate hemangiomatous lesions without physical contact and with minimal disturbance of the overlying skin.

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